Provider Demographics
NPI:1497805998
Name:JOHNSON, EDWARD G (DMD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:G
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 GLENNON FARM LN
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:NJ
Mailing Address - Zip Code:08833-4504
Mailing Address - Country:US
Mailing Address - Phone:908-832-7230
Mailing Address - Fax:908-832-8998
Practice Address - Street 1:420 MAIN ST
Practice Address - Street 2:
Practice Address - City:BEDMINSTER
Practice Address - State:NJ
Practice Address - Zip Code:07921-2604
Practice Address - Country:US
Practice Address - Phone:908-781-0095
Practice Address - Fax:908-781-1170
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22D1013339001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice